Most individuals in health care facilities are able to achieve sufficient caloric intake through eating prepared meals. However, a sizable number of such patients are unable to ingest enough solid food to meet their body's needs. Examples of these individuals would include stroke or neurologically impaired patients, who have lost their ability to swallow effectively; critically ill, weak or comatose patients, who may be unable to chew sufficient quantities of food; patients suffering from obstructive lesions, such as cancer of the esophagus, who may be unable to swallow their food; and patients with head and neck trauma, such as fractured jaws and gunshot wounds, who cannot chew solid food. For these patients, caloric supplementation through parenteral, also known as intravenous, feeding is not the method of choice.
In response to this problem, liquid foods have been developed for enteral feeding. Typically, enteral feeding utilizes a nasogastric tube to transport the liquid nutritional products from a container through the patient's nasal cavity and thence into the stomach. However, increasing numbers of patients utilize enteral feeding through gastrostomic feeding ports. The gastrostomic feeding device or gastric portal is placed into a stoma and the device typically features a valve to prevent gastric back flow, a relatively cylindrical component which extends through the stoma, and a tip portion which precludes easy withdrawal of the device or port from the stoma.
While it is possible to place the gastric port by means of a surgical procedure utilizing a general anesthetic, the preferred method for placement of these ports is through a percutaneous endoscopic gastrostomy (PEG) which involves the non-invasive surgical creation of an artificial opening into the stomach through the abdominal wall using only a local anesthetic. In a PEG procedure, an endoscope is passed down the throat until its terminus contacts the interior of the stomach. A needle is then externally inserted through the various tissue layers, until it enters the stomach at a predetermined point. The needle is retracted and a guidewire is then inserted through the stoma. The terminal end of the guidewire is grabbed or seized by the endoscope and retracted up the throat. A tapered catheter, preferably plastic, is then externally inserted with the assistance of the guidewire so as to form, upon removal of the catheter, a channel wide enough to accommodate a gastric port. Commercially available examples of these gastric portals are STOMATE (a trademark of Ross Laboratories Division of Abbott Laboratories), the BUTTON, (a trademark of AMT, Inc.) and GASTRO-PORT, (a trademark of Superior Biosystems, Inc.). These gastrostomic feeding ports come in several lengths to correspond to the variance in distance between the interior of the stomach and the patient's outer layer of skin. For example, obese individuals would require gastric ports with a longer connecting tube than a child.
Those skilled in the art of gastric portal placement know that it is important to choose a gastric portal with approximately the correct length of connecting tube. However, rather than resort to trial and error, the prior art has relied on stoma measuring devices which resemble an "L" or a "J" in shape.
These prior stoma measuring devices have a shaft which is longer than the distance between the interior of the stomach and the outer layer of skin. At the distal end of this shaft is a hook portion approximately perpendicular to the shaft, so as to have the device resemble the letter "L", or semi-circular in shape, such that the device resembles the letter "J".
When using the prior art devices, the hook portion is inserted into the stoma, with the relatively rigid shaft following. Some distention of the tissue layers will occur since the distance between the tip of the hook and the shaft is greater than the initial diameter of the stoma. Once the hook portion of the device is believed to be in the interior of the stomach, the hook portion is caused to come into contact with the stomach lining. At this point in time a measurement is taken which in theory corresponds to the distance between the supposed interior of the stomach and the outer layer of skin. However, the prior art devices suffer from three main deficiencies. First, the insertion of the device and/or its subsequent withdrawal may cause a laceration to form due to the irritation associated with the shapes of these devices. Secondly, to the extent that the hook portion becomes deformed while being inserted, the stoma measurement provided may not be accurate and third, the need to position the tip of the hook securely on the stomach lining for the actual measurement, has the potential to injure the stomach lining, especially if the individual performing the measurement is unsure whether the tip has come into sufficient contact with the stomach lining.
It is thus apparent that the need exists for an improved stoma measuring device which provides accurate readings, while at the same time overcoming the drawbacks associated with existing stoma measuring devices.